Book reviews

Six book reviews in the January 1999 edition of Notes and Records: Archives of the Scientific Revolution. The formation and exchange of ideas in seventeenth-century Europe,Michael Hunter (ed.). Flamsteed's stars, new perspectives on the life and work of the first Astronomer Royal (1646-1719), Frances Willmoth (ed.). M. Basso Ricci, L. Cafaraella, A. Meloni and P. Tucci, Due Secoli di Strumenti Geomagnetici in Italia (1740-1971). Two Centuries of Geomagnetic Instruments in Italy (with a summary in English). Frank Smithies, Cauchy and the creation of Complex Function Theory. The correspondence of Charles Darwin, volume 10, 1862. Frederick Burkhardt, Duncan M. Porter, Joy Harvey and Jonathan R. Topham (eds).

quent in northern or southern countries ? The first is answered in the negative, without any reserve^ though frequent instances occur of the disease attacking more than one person in the same family. It appears most frequent in northern countries, and in maritime districts. That it is more frequent than formerly, appears ascertained by the bills of mortality, as far as they can be depended upon j and, if we may add our own opinion, we should not scruple to confirm such a report, and strengthen it by a remark we have made, that inflammatory diseases of all kinds have increased in number and violence. ' The Transactions of the Medical Society. 129 The 3d inquiry is, What are the common accidental causes of croup; and what the circumstances which propagate it in one country more than another ? The 4th, The relative mortality of the disease ? 5th, The general treatment? And 6th, Is there any special treatment for croup? AH these questions are answered with very great attention, from the author's own observations, and the facts he has collected by conversation, epistolary inquiry, and printed authorities. The whole affords a truly valuable and comprehensive dissertation on this formidable disease, conducted by a gentleman, who, from his well-known talents, aided by extensive practice in a crowded neighbourhood, is probably the fittest practitioner that could be selected for the purpose.
Art. IV.?Account of Three Cases of Extraordinary Periodical Sickness, two of which were cured by Arsenic; by Joseph Adams, M.D. &c.
These cases are highly interesting, and show in a very pointed view the effects of this powerful remedy. Art. V.?Case in which nearly an Ounce of Sulphuric Acid had been swallowed ; by the same. The vitriol appears by the account to have been vomited in the presence of Mr. Aldridge, the surgeon in attendance, ten days after it was swallowed. We shall offer only the reflections with which the paper concludes.
" On a review of this case, I am aware that considerable scepticism will arise coucerning the length of time which the vitriol remained in the stomach; and, perhaps, concerning the possibility of a delicate female recovering from the violent effects of such an accident. I have, however, related the events as they occurred, with the authority on which each of them rests. I shall now add, that to me they are all satisfactory. The mode of accounting for them must be left to those gentlemen to whom we are so much obliged for their experiments in animal chemistry. From some of these we learn, that the vitriolic or sulphuric acid does not affect living animal matter, and that it coagulates mucus. If I am right in this, the above history may be explicable in the following manner: the vitriol was swallowed early in the morning, before any kind of food or drink had been taken to wipe off or dilute the mucus of the mouth, throat, or tesophagus. When received into the stomach it would coagulate the mucus with which it came into contact, and stimulate the stomach to secrete more. By these means it might have been contained in a number of cysts of coagulated mucus, or in one or two large cysts which might have been thrown up at the time Mr. Aldridge perceived the stain and consequent hole in his coat. At the same time, it can hardly be expected that these cysts would be sufficient entirely to preserve all the acid from contact with the sto-No. 222. s maeh, 130 Critical Analysis. macli, which, being denuded of its proper mucus, might be inflamed to a certain degree, and thus secrete a substance consisting partly of blood, which, when thrown from the stoniach, has frequently this black appearance. " This suggestion will, I hope, be considered only as hints for the consideration of those gentlemen who have devoted so much time, and with so much success, to this branch of medical science; and, if any better solution of the difficulty should occur, I shall gladly receive it; at the same time, I should be sorry if the relation should excite so unjust a scepticism as to supersede all reasoning on the subject." Art. VI.?A Case of I.usus Naturae of the Female Organs of Generation; by Wm. Gaitskell, Esq. Surgeon. In this subject the vagina ended in a cul cle sac, instances of which have occurred before. The author's reflections^ however, are judicious, and his authorities numerous and v.rell selected.
Art. VII.?Case of the Vermis Lumbricus perforating the In* testinal Canal and Abdomen ; by J. C. Lettsom, M.D. &c. An abscess, formed in the integuments of the abdomen, when opened, emitted air and pus. After a few days, " On removing the poultice, a pointed substance in motion appeared in view. It was taken hold of between the fingers, carefully drawn through the orifice, and proved to be another vermis lumbricus in a living active state, in length about nine inches; small air bubbles occasionally appeared ; as well as some faeculent matter; both ceased in a few days. For some weeks afterwards, no faeces were discharged through the wound, but seeds of apples or pears, which she had swallowed with these fruits, occasionally protruded. This ceased before the month of December, the orifice of the abscess had cicatrized, and an accretion of the body was perceptible." Some practical remarks follow particularly on the use of ol. terebinthinse in worm cases.
Art. VIII.?Case of Diseased Action of the Heart, effectually relieved by Blood-letting, and Confinement to a Horizontal Posture; by H. Clutterbuck, 1V1.D. F.M.S. The importance of this case, related as it is with all possible brevity, induces us to transcribe the whole in the author's words. " Mrs. Churcher, thirty-five years of age, wife of a person in the ?employ of Messrs. Calverts, brewers, applied to me Oct. 20, IS 14. She had just walked from her own house, a distance of about half a mile. " Her general appearance at this time was exceedingly distressing. Her countenance expressed great anxiety. The skin in general was perfectly pallid and ex-sanguine, except on the cheeks and lips, 2 ' which Traiisactions of the Medical Society. 131 which were of a leaden hue. The tongue was clean and moist, but as colourless nearly as the skin itself. Her extremities were cold; pulse weak and irregular; breathing much oppressed; the face looked full and bloated ; the legs were swollen as high as the knees.
" She complained of constant uneasiness in the region of the heart, which was affected with frequent palpitations, sometimes coming oii even when lying down in bed, but always upon walking, or auy other bodily exertion; and, at these times, the pulse at the wrist becomes irregular. Upon making any unusual exertion, this uneasiness is aggravated to the degree of acute pain, which extends to the back, collar-bones, and middle of the upper arms, particularly the left. The menses, she observed, were regular in their periods, but trifling in quantity, and nearly colourless. She fancied she had hardly any blood in her veins; for she said, that, when she accidentally pricks her finger, so as to draw blood, the fluid that issues scarcely stains linen. Her appearance altogether was that of the most complete state of chlorosis, with not a few of the symptoms of hydrothorax or hydrops pericardii. " Her appetite was extremely bad: she felt always great uneasiness after eating; and the constricted state of her bowels required a constant employment of purgative medicines. Her general strength, was greatly reduced; and this, with the. growing severity of the symptoms, seemed to indicate much danger, of which she herself was very apprehensive. " The symptoms now described had continuedfor several months, and were gradually increasing. They came on soon after a severfe attack of inflammation In the chest, which she suffered about a year ago. " On visiting her the next morning, Oct. 21, at her own house, in consultation with Mr. Key, surgeon, of Fenchurch-street, we found the violence of the symptoms much abated, from her being in a state of rest, and in bed; and the pulse was tolerably regular. " The symptoms above described sufficiently indicated an excess of irritability and disordered action in the heart; while their duration, severity, and their having succeeded to an attack of inflammation in the chest, gave reason to apprehend, that the disposition to such irregular action in the heart, was the consequence of some disorganization having taken place. " The constant and, at times; severe pain the patient suffered, and the gradual increase of the disease, rendered it probable that the diseased and inflammatory action was still going on; and all hope of relief appeared to me to turn entirely upon our being able to check its further progress. No means seemed so likely to effect this desirable object as blood-letting. Notwithstanding, therefore, the debilitated and, seemingly, bloodless state of the patient, it was determined to make a cautious trial of it. Upon the pretext of examining the state of the blood, about five ounces were drawn frotu the arm, though not without much reluctance on the part of the patient ; she bore it, however, without inconvenience. After the blood s 2 ? bad 1S2 . Critical Analysis. had coagulated, there was observed a full proportion of crassamenturn, which was of the ordinary consistence, and somewhat cupped or contracted in form, but without any buff upon the surface of it. There appeared to be either a deficiency of the red particles, or else they wanted their usual florid colour, the crassamentum presenting almost a leaden hue. " The patient experienced evident relief from the loss of blood, and the road to further probable advantage seemed by this to be pointed out. The digitalis was administered in small and frequent doses, as a means of lessening the irritability of the heart; as was the ammonia in small quantities, with the view of exciting a little the action of the stomach, and of determining the circulation to the extreme parts. Aperients were exhibited in such quantities as to ensure several evacuations by stool, daily?the use of plain, easily-digested animal food was allowed, as the appetite might require; all strong drinks were prohibited, as they had always been found to aggravate her sufferings; and, above all things, perfect quiet of body and mind, and a horizontal posture, were enjoined; and, for this purpose she was confined to bed almost entirely for the space of ten weeks.
" The blood-letting was repeated at intervals, and the plan altogether persisted in, with great regularity, for nearly three months, with gradual and continued amendment; and, at theeud of this period, her health was perfectly restored. She had lost every uneasy feeling about the chest; the pulse became quite regular, and of its natural strength and fulness; the swelling of the extremities disappeared ; her appetite returned, and the bowels acted readily with very little aid from medicine. The menses returned at their regular periods, and, the last time, in a perfcct manner, both as to quantity and colour. Her complexion, also, was now as good as at any period of her life. " She was bled, in the whole, four times from the arm, and once by cupping, from the nape of the neck. From ten to twelve ounces of blood were taken away on each occasion after the first. The time preferred for the purpose was immediately after each imperfect attempt at menstruation. Four or five evacuations by the bowels were procured daily, by small doses of aloetic pills, with which a very small quantity of sulphate of iron was combined. " I have not mentioned a troublesome beating which she felt in the head, at the time that the heart acted most irregularly; as this symptom appeared in a secondary light only, and it yielded with the other symptoms. " I have related this case, as it appears to me to establish some useful practical points. It serves to show, that symptoms of an alarming kind, seeming to indicate an organic affection of the heart, (or which, at least, threatened to terminate in disorganization,) are not altogether hopeless; that a case which seemed of all others, from geueral appearances, and according to general opinion also, to be the most unfit for blood-letting, not only bore this evacuation with impunity, but evidently was effectually relieved by it. And, if so, Edinburgh Medical and Surgical Journal. 133 so, it appears further to be probable, that the employment of remedies of an opposite nature, such as tonics and stimulants, which are generally had recourse to in such cases with a chlorotic character, and with swelled extremities, would not only have proved unavailing, but, in all probability, have aggravated the disease. " I am disposed to attribute much of the advantage received in this case to the strict confinement of the patient to the horizontal posture for such a length of time. I was induced to insist upon this, from knowing the effect which the erect posture of itself has in quickening the pulse under all circumstances; and, particularly from observing the great distress the patient suffered from every bodily exertion. " August 1815. I am now, after the lapse of ten months, enabled to state, that the patient has continued to enjoy perfect health." [The remainder of the papers will be noticed in our next and Senior Physician to the Clifton Dispensary.
" I WAS induced (says Dr. Chisholm) to contemplate the subject of the following paper, as it relates to facts abstracted from speculation, by the result of four years' observation of the diseases of Clifton, as they passed in review before me at the Clifton Dispensary. The facts which further investigation of the subject brought into view, appeared to me highly important, and almost, if not wholly, conclusive, as to the question whether the infection of typhus is specific or not 1 In the adduction of facts, I have carefully avoided those of a doubtful nature, and have given preference to those of which I acquired a knowledge from the information of gentlemen connected with, or in the immediate medical management of, large hospital, dispensary, or public school establishments, within the limits of the city of Bristol. " There is, perhaps, no mode of acquiring a knowledge of what may be called statistical pathology so perfect as a parochial or district dispensary. The objects of such an institution are confined to that description of people who are most exposed to the action of local causes of disease, whilst their mode of life removes them from those of an artificial nature. Luxury, with all its attendant evils, has no place in their domestic establishments?superfluity, of every kind, they are unacquainted with, unless it may, unhappily, be that of distress and poverty?whatever morbid causes proceed from the nature of situation and soil, from the changes of the atmosphere, from imperfect ventilation, from the accumulation of filth, from crowded small 154 Critical Analysis. small rooms, and from poor and scanty diet, these people are the subjects of; and hence a correct and well digested register of their diseases becomes a faithful record of the pathology of such parish or district." Nothing can be more just than this general proposition, so far as it relates to the knowledge of a district, of the prevailing diseases, and the general inferences deduceable from the whole. The theatre of our author's present practice is so generally known, and, for the most part, so similar to that of other large towns, and their extensive suburbs, that we need only mention a few local peculiarities connected with the period at which these observations were made.
Respecting climate, we are ready to admit, that, in the higher parts of Clifton, it is, if possible, more inconstant than in most other parts of our island. The westerly winds, which, in many places, are mild, arrive here fresh from the ocean, and have a most unfavourable influence on vegetation, as well as on .the human frame. The increased population has been chiefly in the more exposed parts, and confined to those individuals whose circumstances are easy. These, therefore, must be left unnoticed when speaking of typhus. ?.'Such local advantages," continues our author, " would be effectual in excluding a morbid constitution, had the inhabitants themselves contributed their own exertion. But here are .the unpleasant features of the picture. Nearly threefourths of the population of the parish are confined to that part called the Hot-well Road, extending about a mile in length along the western bank of the Avon." This description is continued for some length, and with a detail of every disadvantage. Yet, in the midst of the whole, it is impossible not to remark, that three-fourths of a population of 90.00 is less than 6000 which extended for the length of a mile along the banks of a rapidly-flowing river, however narrow the space occupied by their dwellings may be, they can never be considered as destitute of free ventilations. That the effluvia from these houses will often be unpleasant to those who are accustomed to the luxuries of better life, cannot be questioned; but the air cannot stagnate for any length of time, especially when we consider the cheapness of fuel as far as that river extends. Add to this, where there is a disposition to " religious observances, and to the perusal of religious books," there must exist a degree of order which implies cleanliness, at least on the return of each weekly festival. In all this account, therefore, we see no cause for the production of typhus $ for we perfectly agree with, Dr. Chisholm, that the emanations from putrifactive matter are not the causes of infectious fever. For arguments in proof Of Edinburgh Medical and Surgical Journal. 1 S3 of this, we are referred to the Doctor's paper, Edin. Med. and Surg. Journal, vol. vi. p. SS9; and, to prove our acquiescence in the same, we refer our readers to our xxivth vol. page 422. We shall hereafter show our opinion of the effects of vegetable and animal putrifaction on'the human health; but we do not conceive that they make any necessary part of an inquiry into the origin of typhus fever.? We should beg Dr. Chisholm's pardon, and congratulate ourselves in discovering, that.this learned author seems disposed, at least for the present, to divest himself of the term typhus, and to substitute another, in which we most heartily accord with him. " In such a state of things, (says he,) were we to form our opinion by the usual speculations, founded on imperfect ventilation, on the accumulation of filth, on crowded habitations and rooms, and the squalor of the persons inhabiting places subject to such supposed causes of disease, we should infer that the Hot-well Road, or town, was the very abode, the very centre of infection. It will appear, however, from the appended table of diseases, that, although much disease has existed, the supposed offspring of the circumstances I have stated, typhus, or a lever of infection, has scarce a place.
How can this be reconciled with what we hear and read of the ravages of such diseases in many of the larger cities and towns of the United Kingdom ? It must be confessed, indeed, that the fluctuation and instability of opinion respecting infection, have been as great as they are unaccountable. We may, however, trace their origin to prescriptive ideas. jFilth and infection seem closely allied, seem to bear the same affinity to each other as cause and'effect; and hence it results that a belief prevails that the accumulation of filth, &c. must necessarily be the cause of typhus,?a belief handed down, not inquired into, and, consequently, converted into an established fact,?an axiom in physics. Little research is instituted, and mankind continue to think and act on a faith not.sanctioned by true philosophical principles." This subject is continued through several paragraphs; but, as we have never considered putrifaction the cause of infectious fever, it is enough that we have shewn there is no want of ventilation, or even of that change in the condition of the air which a weekly cleanliness must, to a certain degree, produce. That, however, the inhabitants do not enjoy vigorous health, is evident, from their " squalid appearance," which, wre suppose, is not completely changed by their Sunday ablution and change of dress.
"Fevers of infection" it is afterwards remarked, "are more prevalent in manufacturing than in commercial towns." The reason of this will be considered hereafter. At present Ave shall only stop to remark, that, if such is the case with fevers of infection, we shall hereafter shew that with some other 136 Critical Analysis. other epidemics the contrary will be found to take place. !Nor can we impute this difference to the causes assigned by the author, namely, " that the unnatural state in which the inhabitants of manufacturing towns are placed, may dispose to the generation in their systems of that unknown virus, or poison, called typhous infection; whilst the active bustling, and more natural condition of the inhabitants of commercial towns, preserves a due balance in their systems, by throwing off those secretions, useless in the organization of the human body, and injurious to its health when retained." It is extremely difficult to follow Dr. Chisholm-The following sentence, however," is so precise, that we may fairly quoie it as his fixed opinion. " Indigence and sloth," says he, " are often found in the same person, and, when they are, then the retribution necessarily attached to such an unhappy union may be perceived, and may be felt.
Such an union I conceive to be the parent of typhous infection: such a^i union, therefore, it is the business, and ought to be the duty, of the enlightened and humane, and more especially if placed in authority, to prevent by all possible means; for, although it may not always be destructive to the individuals themselves, in whom it originates, it must, and is always so to all who come within the radius of the infection which emanates from it." Here, then, we have the author's decided opinion of the origin of that substance which induces the infectious fever. Let us now attend to bis account of the manner in which its influence spreads.
then, that the parties should be placed in a "peculiarity of circumstances ?" and is it not absolutely necessary that such peculiarity of circumstances should be accurately traced before any inference can be drawn relative to contagion, infection, pestilence, or miasma? We may further remark, that, though those fevers which occurred at Clifton are called typhus, and probably might have the low type which ought to characterise that disease, yet we have no proof that there have been no other causes for such fevers. Is not the despondency which lately pervaded so many classes sufficient to induce tever, and fever of such a description ?
Dr. Chisholm proceeds to make some remarks on the various and incorrect manner in which the word typhus is often applied. Of this we have said enough on many former occasions. Some remarks follow on the Bristol Infirmary, the return of sick for three years, and-the proportion of fevers called typhus, but which Dr. C., with much propriety, conceives arise from miasma of soil more thaii any of the common causes of infectious fever.
An account follows of St. Peter's Hospital, which, as far as we can judge, is similar to what the London Work-house ought to be, namely, a receptacle for those poor who cannot claim a settlement, or who are not in a condition to be removed to it. From the care taken to preserve order and cleanliness, t? infection has never been generated in the house"?an expression which implies, that, with less care, such an event might have occurred. Ever since the docks have been formed, this hospital has been more subject to sickness. This is very reasonably imputed to the want of that drainage which the building formerly received from the flow of the tide instead of the stagnant water. " The disease observed as more particularly produced by the exhalations from the almost stagnant water of the river, thus become a floating harbour, is a low fever, partaking much of the nature of synochus, but marked with indistinct intermissions. The number of cases of typhous or infectious fever has been 50, during the period from 1st January, 1813, to 31st December, 1816; aud of these sixteen have died, or one in rather more than three, a proportion far exceeding what has happened at the Bristol Infirmary, during the same period, and which seems only to be accounted for by the symptoms of the disease acquiring more violence from the insalubrity of the situation for some years past, and by the condition T 2 of 340 Critical Analysis of many of the subjects when brought into the house. The result, however, furnishes an additional and satisfactory proof, that the virus of typhous infection is specific; for 110 establishment of the kind can be kept in a more perfect state of cleanliness and ventilation, and, in every instance, the infection appears to have been traced to a source foreign from the house itself. Since the beginning of the present year, i. e. from 1st January to lQth March, 1817, about twenty cases of typhus have occurred. The infection was introduced by a wretched coloured man, found destitute in the street, and received into the house, without the nature of the disease he laboured under being ascertained." The reader will regret with us, that the fevers and their causes are here too much confounded. However, it would appear, that by great cleanliness the infectious fever, when introduced, may be prevented from spreading, and that it becomes more fatal and more general by the accumulation of filth. We are not now offering our own opinion, but what we conceive the fair inference deduceable from Dr. Chisholm's statement; for we are very far from being satisfied "with the confused manner in which the first string of inferences is.drawn. " The foregoing facts tend to establish only one partition of the proposition, viz. that typhous infection is not the offspring of Jilth, crowded unventilated rooms, &c.?it remains to adduce facts which go to the establishment of the other partition, viz. that typhus infection does exist, and may be propagated in places the most clean, most freely ventilated, and in all respects the best regulated. If such can be adduced, then the proposition, I apprehend, may be deemed proved, that typhus infection is specific, and not the produce of adventitious circumstances. In this last respect, Bristol is by no means exempted from infection: but, of many instances which could be given, I shall select the following from among public schools, in a charitable foundation, as it seems to place the subject in a particularly clear light." Now, in our opinion, jilth should not be confounded with *00ant oj ventilation, as we find it in the beginning of this proposition. Next, we would ask, if typhous injection may be propagated in clean and well ventilated places, what is meant by the word propagation? If only that it may be communicated, we have already admitted as much. But may not its further propagation be arrested by cleanliness and free ventilation, and has not the establishment of St.
Peter's been brought as a proof of this ? May we not further ask, is there any kind of cleanliness or ventilation that will prevent the propagation of small-pox ? On the contrary, does it not extend with more certainty in the pure air \of a village than in the corrupted air of a large town.
If we understand Dr. Chisholm, no want of ventilation, 141 no filth, are sufficient to generate that condition of the atmosphere which produces infectious fever. In answer to this, we are ready to admit two things, first, that fever is most commonly introduced into such places, and, even when we are ignorant of such an introduction, it may have existed. But it is certain, that fever from such a cause spreads only ill crowded and ill-ventilated communities ; and, also, irom the frequency with which it is found in camps, Heets, and prisons, and from the circumstances under which it occurs in such places, there is every reason to believe that it is generated by such circumstances. Justice to L)r. C obliges us to insert the whole of the following long paragraph.
" Another source of error, or rather of misconception, with respect to the existence of typhus infection among the indigent inhabitants of Bristol, is the occasional occurrence of scarcity of provisions, almost amounting to famine, and the substitution ot corrupted or not sufficiently nutritious articles of food. I engaged pretty largely in the discussion of this interesting subject on a former occasion (see Edinburgh Medical and Surgical Journal, vol. vi. p. 412-415); and I have reason to believe the conclusions 1 there drew are correct and satisfactory. Several instances are on record of epidemics beiug the consequence of scarcity of provisions and deteriorated food in Bristol; but, from what lias been stated in the work referred to, and from the imperfect, information 1 could obtain of the nature of those epidemics, I am induced to relinquish every idea of their originating in infection, although the ubual, indeed general, opinion entertained is, that they jvere infectious, or typhous fever. In the annals of Bristol, instances are recorded in the years 1597, 1608, 1752, 1765. The must recent happened, 1 believe, in 1795 and 1799-These were attended with a very fatal epidemic fever. Many afflicting details of the disastrous consequences have been given to me by gentlemen, who, as agents of charitable societies, took a very active part in the investigation of cases of distress, and in their relief. Misery of every description prevailed; but the fever, as far as 1 could collect from this source of information, was evidently a fever of exhaustion, not of infection. From the medical gentlemen who at that time practised in Bristol, I could obtain 110 precise account of this direful calamity,?a deficiency much to be regretted. That famine may sometimes be the precursor ot pestilence, I believe; but it is not so from the mere privation or deterioration of food; it is from the superinduction of infection, to which, under such distressful circumstances, the poor are more exposed. Riverius has observed, ? Quando magna adest annouze caritas et penuria, unde vulgare illud, 0 ^sr' pestis post fa men.' It is a vulgar observation, but it is also a vulga. error. A disease, however, equally fatal, dues ari->e from the exhaustion consequent upon famine; and, the symptoms of it assuming uie .eatures, in some de- Is translated ' they shall be burnt with hunger,'?(Deutr. xxxii. 24.) This is the denunciation of the Almighty himself, and is as awful as it is grand. The expression has been variously rendered, according to the conception of the effect of famine formed by different nations. Thus in the Septuagint it is ryiKo^tvoi liquescentes fame; the Latin version of the Syriac has it conturbabuntur fame; of the Chaldaic, inflati erant fame; but the original in one word comprehends the whole. Although rather foreign to the object of this paper, I cannot forbear giving myself the gratification of directing the attention of the reader to a valuable paper of Mr. Bacot's, in the seventh volume of the Transactions of the Medico-Chirurgical Society of London, in which a most instructive description is given of this species of asthenia, as it fatally prevailed in a battalion of the guards serving in Spain in 1812-3. I the more readily insert it here, because it is a disease that I believe has never been accurately described before. ' The patients usually came to the hospital complaining of chilliness, languor, and depression, both of strength and spirits; the countenance wan and melancholy; the pulse small, frequent, and tremulous; and the surface of the body unusually cold to the touch. Giddiness of the head was a frequent complaint, and a deep and constant sighing was an universal symptom; yet there were none of the common attendants of the first attack of fever, no violent headach, nausea, or thirst, no accession of heat, or marked rigors, in the first instance. I have seen numbers of men brought to the hospital so attacked die in twenty-four or thirty-six hours after their admissiou, without a prominent symptom, insensible to every kind of stimulus, and never having any accession of heat or increased action of the vascular system, from the moment of the attack to the hour of their death. In many men of very robust habit, the disease assumed more of the common forms of fever, and very soon put on the typhoid character, with parched tongue, low muttering delirium, and terminating, in some instances, in a suffusion of bile over the whole surface of the body.' (p. 379.) This is the disease so often among the poor mistaken for typhus, because frequently whole families are prostrate under its direful influence. Many instances of this occur every winter, but at the periods stated more remarkably, because the cause more extensively and more severely existed. The present year would have pre-eminently furnished elucidations of this fact, had not the consequences of famine been in a great degree averted by the extremely judicious measures adopted by the mayor, and cheerfully acceded to by the more wealthy inhabitants. It may not be irrelevant to remark, that the misapplication of the word typhus, so frequently occurring in this lamentable species of asthenia, may serve, perhaps, as a guide in detecting Edinburgh Medical and Surgical Journal. 143 detecting similar misapplication in those extraordinary accumulations of fever inserted in the reports of fever under the denomination of typhus, which we hear and read of in other towns and cities equally populous as Bristol, and equally exposed to the causes of asthenia abstinentium." We confess some parts of this are so much like what i* usually called typhous fever, that we know not how to make the distinction. We prefer the word Camp Fever, and leave our readers to the description, as they will find it in various writers, particularly in Dr. R.Jackson, whose name we have so frequently introduced, and our remarks on whose works occur in so many of our volumes.
The remainder of the paper consists of very long and learned quotations and authorities concerning the periods at which epidemics have visited Bristol and other places. After which, follow a table of the diseases relieved at the Clifton Dispensary for three years. The number of patients amounts to 1699, of whom uiecl 101, or about one in seventeen.
Among the fatal cases, phthysis makes twenty-three ; of rubeola, five in fifty-five, a large proportion in a disease ge* nerally considered mild; of typhus, sixteen, of whom onequarter died. We were struck with some of the names: scrofula vulgaris, fifty-four, of which two died. What is scrofula, and what are the other distinctions ? Elephantiasis* on the other hand, has no specific or trivial name, yet the various senses in which authors use that word are repeatedly noticed.
Such are the general outlines of this long paper. We know not in what terms to speak of it, and trust the ambiguity of some parts will be a sufficient apology for our requesting Dr. Chisholm to revise it, giving a precise meaning to each of his terms. This we particularly request, as it may furnish 11s with many useful hints when we venture to accomplish our promised dissertation on Contagions. At present we shall only in general remark, that we wish to confine the word contagion to diseases, which, under all temperatures and in every known state of the atmosphere, spread from a diseased subject to all who are susceptible of the same, and which can originate as far as our knowledge now extends from no other cause; that marshes produce intermittents or remittents, in proportion as their myasma is more concentrated ; that filth has an effect on certain pestilential diseases; and that camp, hospital, or gaol, fever may be generated wherever sick of any description are crowded. An Appendix, by Mr Chisholm's, that we have been induced to insert it here, though not in order. It is a very useful paper, and shows industry, genius, and many very good qualities. It is not, however, without very considerable attendant faults. These % we excuse in the writer on account of certain passages which, in justice to him, we shall transcribe in his own words. They are contained in the introductory and concluding parts of his letter. " I now set myself down to give you a brief statement of the observations which I have made respecting the fever of the West Indies. We have suffered severely by it; and I have to lament the loss of two of my dearest friends, who fell early victims to its indiscriminating malignancy. My opinions concerning its origin, nature, and cure, differ in some degree from those of all the other medical men on the station ; 1 am, therefore, induced to lay before you the result of my experience, for the benefit of your friendly inspection; and shall expect your observations thereon with the greatest anxiety." The writer concludes. " I have now given you the sketch which I promised, as far as I observed the nature and course of this fever in the Antelope and Childers, and I beg that as soon as possible you will write to me, aud let me know in what we agree and disagree on this subject. If you think this letter worth inserting in any of the medical journals* you are at liberty to do so, or as you please with it. When in the Childers, I had a most severe attack of this fever, and was given over by the physicians at Barbadoes Hospital for five days, but I recovered." , By these passages it is evident, that Mr. Birnie, who is an assistant-surgeon, conscious'of his own want of experience, has given only what he observed in the Antelope and the Childers, waiting with much anxiety for his friend's opinion, and committing the fate of his letter to the same friend. After this, we are obliged to address our animadversions to Mr. Scott, a/tt//-surgeon in the royal navy. For the same reason, we shall be as sparing as possible of remarks, and copious in extracts, considering that, in a production like the present, the facts related are all that the writer is answerable lor.?The writer continues, " Like every other non-tangible subject of importance, the feveis of the West Indies have engendered a vast variety of opinions.
The Edinburgh Medical and Surgical Journal. 145 The utility and beauty of classification have given way to the rage of discovery; and every one comes forward with his little bit of an hypothesis to set the world to rights, and claim the rewards of genius. Had I not matter of greater moment to communicate, I could give you great amusement by the recital of many an absurd explanation of the nature and causes of yellow-fever. I shall here attempt to disprove all the great positions of Mr. Pym. His own words, the authorities he quotes, and the result of my own experience, have led me to a very different conclusion from that which he has adopted; but, as I am a young man, and a very young practitioner, as my opportunities for observation have been few, and perhaps my attention slight or ill-directed, it would ill become me to be dogmatical. I shall, however, with a faithful, though feeble, hand, trace what I have seen of these diseases, endeavour to prove their individuality, and that they are generated in the West Indies, without a possibility of supposing their origin or increase to have been at all connected with contagion. " Mr. Pym is the first, as far as I know, who has attempted to prove tiiat the fevers of the West Indies differ with regard to their nature and origin. He divides them into three kinds, the continued bilious, the remittent bilious, and the Bulam or yellow fever. His diagnostics are, that, in the first, as the disease advances, the skin becomes of a very deep yellow colour ; in the second, of a deep yellow ; and in the third, of a pale orange colour, with the addition of a peculiar drunken appearance of the eyes. He says, that, in the first, there is never the black vomit; in the second, seldom, if ever; and in the third, always. The mere statement of these definitions demonstrate indubitably that the diseases in question are but grades of the same affection.
Here the black vomit is the only character rislic symptom of Bulam fever (for the drunken appearance of the eyes takes place in fevers of every different type;) and he even allows the black vomit to appear sometimes in the remittent, though he denies it ever to take place in the continued bilious. It is a symptom universally looked on as the immediate precursor of death, and cannot be called a diagnostic. This is a brief statement of Mr. Pym's doctrine; and I shall now proceed to lay before you as short and clear a view as I am able of the forms under which I have seen the endemics of this country, by which you will be enabled to judge of the argument and its utility for yourself. " Immediately after our arrival in this country, about the beginning of March last, when the inhabitants of Bridgetown [Barbadoes] were perfectly healthy, and no cases of fever on shore, at least I am certain lhat no one belonging to the ship had been near, or indeed had heard of any, sick person on shore, a fever, characterized by all the symptoms which Mr. Pym has attributed to Bulam fever, made its appearance on board the Antelope; and, since that period, 110 cases have occurred in her, of which thirty-one only have died; of those thirty-one, nine either lived entirely in the fore and after-cockpits, or messed, and, consequently, passed the greater part of their time, there. None who had black vomit recovered; and of the >io.222. U thirty-thirty-one, seven only had black vomit; and of these seven, six were of the nine mentioned above as living almost entirely below, where the atmosphere in this country is thick and heavy, and produces a peculiar hot sensation on descending from above into it. The temperature is always about the same, is often below what it is on deck, and, from the continual burning of candles, the crowding together of several people, the debris of pantries and mess-rooms, not always exceedingly clean, together with the want of circulation of air, may have caused so great a proportional number of those who were obliged to mess or live below to die, and have black vomit. If we compare the mortality amongst them to that of the rest of the ship's company, I conceive the observation will be of infinite importance in a future stage of this investigation. The patients at first universally complained of a pain extending across the forehead, confined to a line above the eye-brows; frequently the eyes could not bear the light, and pain was always produced by slightly pressing on the eye-balls; the pulse was sometimes natural, at others full, quick, or interrupted ; the skin always hot, dry, and pungent; irritability of stomach came on on the first, second, or third days; the matter rejected from the stomach was indigested food or drink, bilious matter, and, in several, towards the latter stage, that peculiar secretion called black vomit. We have lost fourteen officers and seventeen men by this disease, and it possessed, in an eminent degree, all the symptoms attributed to Bulam fever, particularly black vomit.
Its course was from two to ten days, but generally terminated in from three to four. This is a concise account of the disease, as it appeared in the Antelope, and it was called Bulam fever.
" In August last a disease broke out on board the Childers brig, while anchored in the Gulf of Paria off Port Spain, Trinidad, where the squadron had gone to pass the hurricane months. As her surgeon and assistant were both attacked, I was sent to assist Mr. Brown of the Scamander in taking care of the sick. At that time, twentyeight out of ninety men were labouring under a disease which made its appearance by the same circumscribcd pain of the forehead, affection of the eyes, variable pulse, hot, dry, pungent skin, and succeeding irritability of stomach, which ushered in the disease on board the Antelope. " In the first ten days about thirty persons died: three women and two infants fell victims to it; and this was called bilious remittent. But the only difference which to me appeared to exist between the disease on board the Antelope and that on board the Childers was, that, in the former, black vomit appeared in seven cases out of 110, while on board the Childers 1 observed it in one case only. It was, indeed, said to have existed in the cases of two of the women, but, as I was seized with the disease myself before they died, I cannot assert that they had it on my own authority, and that the disease on board the Childers was attended with a . much greater mortality. But, premising that the same causes do not always produce precisely the ssme effects o;? the human body, this this difference of termination may, perhaps, receive some elucidations from considering the following circumstances. " The disease appeared in the Antelope immediately on her arrival in the West Indies. The Childers had been nearly six months in the country when the disease broke out in her. The Antelope was in good order, clean, and well aired, with the exception of the cock-pits, as already mentioned: the Childers was the opposite of all these. On board the Antelope twenty-five died who had no black vomit; on board the Childers one died who had black vomit.
Can it be supposed, that the twenty-five who died in the Antelope, without having black vomit, were different from those who exhibited similar symptoms and died about the same time, but who had black vomit? 1 think not. When the peculiarly circumscribed pain of the forehead, and the great and almost unconquerable irritability of stomach, were the distinguishing and leading symptoms in every case; because a certain appearance takes place in a limited number, shall we call them by different names? Let us pursue the comparison still farther, and we shall find that the mortality and -liability to attack was equal among those who were obliged to live or mess below in the Antelope, and those who lived on the lower deck of the Childers. The lower deck of" the Antelope, where the people mess, is always well aired, except in a heavy sea, which does not often occur in the West Indies, and is always kept in an exceedingly clean state, which accounts for the disease not running through the ship's company, and for its comparative manageableness; but, in the cock-pits, every person was attacked, except two seasoned hands: about one half died, while, in the other parts of the ship, not more than a fourteenth, viz. nine of the thirty-one w ho died on board her had either lived entirely or messed in the cock-pits, and, of the seven cases of black vomit which occurred on board, six were of those nine. The lower deck of the Childers, where the people mess, was dirty in the extreme. On lifting the hatches of the fore or after holds, a horrid suffocating stench issued from them: it was confined, lumbered with lockers, and the heat increased by the fire-place being on it. It was in a nasty filthy condition, and I do not recollect that it was attempted to ventilate it by wind-sails. This state of the vessel, the want of accommodation and attendance, and the sudden fall of the medical officers, accounts for the mortality on board of her, and the disease attacking all her crew:-?only three escaped,an attack, and about half died. Here we observe a remarkable coincidence between the extent and mortality of the disease in our cock-pits and in the Childers. We see the influence of the climate modified by the different situation of the two ships, and by the different situation of the parts of the same ship.
" From having observed that this influence is the leading character of these diseases; that, in every individual case of them, the first symptom was the circumscribed pain of the forehead, pain of the eyes,.particularly on pressure; that all cases were alike characterised by irritability of stomach and rejection of great quantities of bilious matter; that six of the cases in which black vomit ocu 2 cur red 148 -^Critical Analysis, curred were placed in peculiar circumstances; that the other was in a bilious irritable habit, and took place immediately on our arrival; that, of the thirty-one who died, nine were obliged to be almost entirely below: I say, from having observed all the essential and cognizable symptoms to be the same in both these diseases (though I cannot point out exactly what combination of circumstances, or modification of causes, produced so great a number of cases in our cock-pits, in which death was preceded by black vomit, and why a still more nasty state of the lower deck of the Childers so few), I am of opinion that they are essentially the same, and fear that medical observers, in the too eager pursuit of discovery, have been inclined to look over the thousand phenomena which establish their identity, and to find out and magnify the irregularities which occur in this, as in every other disease. For my own part, I grieve to see so much patient inquiry, and intelligent observation, frittered away in the futile attempt to convert classes inlo species, or in the insignificant invention of a new name for an old disease. As they all agree that the practice in both must be the same,?that this dif-149 the ague appears lower; and that, in very wet ones, the remittent occurs in higher ones/ This gradation will account for these en? demies prevailing in different situations according to the season j and I conceive it to be perfectly conclusive in proving their identity. Speaking of what lie calls Bnlam fever, Mr. Pym says, ' it is a disease, sui generis, of foreign origin, contagious, and attacking a person once only during life.' That it is the same as the bilious remittents, I think I have made sufficiently evident. With respect to its being of foreign origin, I ask, Do the same causes exist no-vvhere for its production but in Bulam? When it has disappeared for many years, or for months, as it did in the Antelope, where did it hide itself; and, being so fatal, how was it concealed and retained in existence ? I consider the doctrine of contagion to be altogether unfounded, and eminently mischievous; and that none of these fevers, allowing a difference, is contagious, 1 think 1 may assert oil the most solid proofs the subject admits of. On board the Antelope, no precaution was taken to prevent contagion, yet, out of 320 men, having the freest intercourse, not more than J 4 or 15 at a time Were attacked.
The surgeon, two assistants, and surgery-man, were always among the sick, and the three last slept continually in the midst of them, and none of them had the sligMest attack ot fever, for many months afterwards, and only the two assistant surgeons, after being sent, one into the Childers, and the other into the Brazen. The officers frequently came to see the sick; their messmates were allowed to visit, wash, and dress them ; yet no appearance of the fever having been ever communicated by contagion occurred. On his being attacked, 1 leut a pillow to one of my messmates, who died eight days afterwards, having had black vomit, yet I slept on it for four months without any other precaution than that of changing its case, and without the least attack of fever during all that period. On board the Childers, where they had the fever, which my medical superiors called remittent, out of ninety men, only three escaped being attacked, and every person impelled by duty to remain for any length of time on board was seized with the same disease. The surgeon of the Brazen sloop had been left behind, and on the brig's arrival (for she had been sent from Trinidad, that her men might be conveyed to the hospital at Barbadoes,) lie nobly volunteered his services, and fell a victim to his humanity. Another surgeon and three assistants sent on duty into her, had very severe attacks; and three clerks, made pursers into her, died in less than as many weeks. This appeared like contagion, but was not, for none of the physicians, surgeons, assistant-surgeons, attendants, or nurses, who were continually with the men and officers after their beiug sent to the hospitals, were ever in the slightest degree affected with any thing like this disease. That the immediate and exciting cause existed on board the brig, is evident from this relation, and from the fact, that her men were taken ill every day, until she was unloaded and cleaned out, and that the black Creoles employed in this service were also seized with the disease in a day or two qftcr being on board, but that since this purgation she has 3 had 150 Critical Analysis* had no new case of fever, and but one of relapse. I noticed above, that one third of those who died on board the Antelope, eilhef messed below, or lived there entirely, where they were, in some degree, under similar circumstances with the crew of the Childers; and I have no doubt, had those strangers who were attacked in the Childers been sent into onr hold, steward-room, or cock-pits, to breathe a close vitiated atmosphere, loaded with every miasm which such a State is calculated to produce, that they would have experienced some similar attack; or, had our ship's company been crowded down there, so many would not have escaped an attack, nor so many who were attacked have recovered. I think sufficient evidence is here given to prove that these fevers are not at all contagious. The fever in the Childers was endemic, not contagious; and it is by confounding the different ideas conveyed by these words, that many wander in a labyrinth of their own construction. This disease is in all cases endemic ; it is the result of the influence of climate, modified by all the circumstances which 1 have already mentioned, and perhaps many others; and it is the different nature of these modifying circumstances that determine its nature and appearances. There is no such thing as idiopathic fever. Every effect must have a cause; and no cause can act in the general system, but must affect it through an organ or set of organs. Disease, as well as motion, must originate from a single point; and the power that affects that single point generates the disease, and the climatc is that power. With respect to the statement that the disease attacks a person once only during life, if the evidence I have adduced to prove the identity of these diseases, and that they are not contagious be conclusive, this position falls of course; and it is well known that the remittents of this country attack the same person frequently, though each succeeding attack is generally milder, in proportion as the constitution becomes creolised." After so copious and uninterrupted an extract, we maybe allowed, without the danger of any imputation on our candonr, to call the reader's attention to certain passages.
1st. That the Bulam and yellow fever arc the same. <2d.
That, on hoard the Antelope, the fever originated in the ship, and the mortality was greater in proportion as the men lived below in atmosphere confined, though often cooler than on deck. Sdly. The mortality in the lower deck of the Childers was very similar to that of the cock-pit in the Antelope. 4thly. Bridgetown was healthy when the Antelope arrived?we ought to have been informed of the health of the squadron in the Gulph of Paria, where the Childers anchored in August. But, 5thly, The lower deck of the Childers was dirty and ill-ventilated, and the mortality great in proportion.
Let us now remark, that the crew of the Antelope, though always clean, was seized as soon as she arrived in the West Indies. The Childers, though dirty, remained free for six months Edinburgh Medical and. Surgical Journal. 151 months after its arrival. The periods of the Tigris, Scamander, and Brazen, are not marked ; but it is observed in all that the degree of disease, was in proportion to their want of ventilation and cleanliness.
Mr. Birnie and his fellowassistant, who escaped on board the Antelope, were seized, one on board the Childers, the other on board the Brazen, both in a similar condition. On board the Childers, even the Creole blacks taken from shore were seized; but the crew sent to the hospital at Barbadoes did not infect anyone, and the ship, when well cleaned and ventilated, was found equally inocuous. From all this, Mr. Birnie concludes, that the disease was endemic, but not contagious; that is, we presume, that it originated with the people. But, says Dr. Ferguson, the type of the disease depends on local circumstances, and is different on mountains, in vallies,, the same country than to the gaol or poor-house fever of England ; and because, in all acute cases, we conceive the symptoms, and not the cause, of a disease, are to direct us in the immediate application of remedies. This case, though by no means uncommon, is extremely interesting. We have several times expressed our wish that, in the treatment of internal tumours, our brethren would show greater courage; and, after the bold attempts latelymade in obliterating large arteries seated within the peritoneal cavity, we may expect that in diseases as necessarily fatal as aneurism, similar attempts will be made. Our meaning will be better understood by giving the leading particulars of the case.
The following are the external indications of the tumour during life.

I'5S
tend about an inch and a half in depth. The sternum being cut from the ribs, and laid back, a considerable quantity of air escaped with violence from the right cavity of the thorax. The right lungwas compressed to the size of a person's hand, and, upon examining its external surface, an ulcerated hole, about the size of a shilling, was discovered, near to its centre, through which the air had est caped into the. cavity of the thorax, and compressed the lung. The internal substance of the lung, when cut into, presented a tubereulated appearance throughout its whole substance. The left lung was also found to be much compressed, and smaller than natural; and its internal structure presented the same tuberculated appear-* ance, although in a much slighter degree. > " The pericardium, containing the heart, was found forced entirely into the left cavity of the thorax, and was pressing upon the left lung, so as to impede, in a considerable degree, its free action. Upon laying open its cavity, there flowed from it about ?vi. of a transparent yellowish-coloured fluid. The heart was larger than natural, much loaded with fat, and its coronary vessels were distended with blood. The right auricle was turgid with blood, partly coagulated, and partly fluid; the foramen ovale was found completely closed; both ventricles were also filled with blood; every other part of the heart, valves, &c. were found to be sound and healthy. The contents of the thorax being removed, its internal cavity appeared to be large and roomy.
?' From want of time previous to the funeral, the cavities of the cranium and abdomen were not opened. and that she.had enjoyed perfectly good health, until withrn tiiesc last two years, when the above-mentioned symptoms commenced, and gradually continued to get worse. The tumour in her neck commenced six years ago, and, when first observed, was about the size of a horse-bean, and, since that period, it has gradually continued to enlarge, but particularly within these last two years.
" The cause of the livid colour of the integuments in this patient (or morbus caeruleus) appears to me to have been owing to the very imperfect circulation of blood through the lungs, and, consequently, to its having beeu very imperfectly supplied with oxygene from the external air during respiration. The right lung, as appeared upon dissection, was compressed to the size of a person's hand, by the quantity of air which had escaped from the ulcerated hole in its surface, and must, consequently, have been rendered almost incapable of performing its natural functions. The pressure of the air from the right cavity of the thorax upon the mediastinum, during the action of the right lung, had also forced the pericardium and heart totally into the left cavity of the thorax, and, of course* greatly diminished the functions and size of the left lung. The diseased tuberculated state of the substance of both lungs themselves must also have contributed greatly to producc the disease. The action of the heart itself and arteries, upon examination before death, appeared to be irregular, stronger, and fuller at one time than at another, which might arise from the pressure retarding their free action. The pressure of the tumour upon the trunk of the left internal jugular vein, particularly when the patient was lying upon her right side in bed, might have produced the great turgescence of blood in the face, and head-ach. " With regard to the treatment of the tumour, in a surgical point of view, there must have been much hesitation and doubt, from the uncertainty with regard to its nature, as by some people it was supposed to be an aneurism, and its connexion with the surrounding parts, which were of such importance to the animal economy. From its immense size,?from the important situation which it occupied, imbedded among the large blood-vessels,, nerves, glands, supplying the head and neck,?from the uncertainty whether or not the common carotid artery might be immersed in its substance,? from its depth, the serious nature of the operation, and the debilitated state of the patient's constitution,?its extirpation was delayed, and she was recommended to the physicians, under whose care she eventually died. By the dissection, all these circumstances were explained; and it became evident, that the tumour might have been removed without risk, excepting from the extent of the wound, and the debilitated state of the patient's constitution, arising principally from the internal disease under which she at the same time laboured." In this instance there was much pulmonary disease, besides the distress arising from the tumour; but it not easy to say bow much of the whole distress arose from the tumour. We perfectly agree with the author in the danger of cutting out such a substance; but we can see no objection to making an opening Dr. Cullen's First Lines of the Practice of Physic. 155 opening through the integuments into the substance.of such tumour. The contents, as far as is necessaiy lor the immediate relief of the patient, would be pressed out by the act of respiration, and though the part might not heal for many months, yet the patient would have a better chance of recovery. In our next, we shall notice the other original articles, which arc more than usually numerous in the number before us.
Though somewhat out of place, we think it right to acknowledge, that, from our eagerness in attending to the important facts in Mr. Birnie's paper, connected vyith prophylactics, we omitted his method of cure. It is " contained in very few words;" and consists, chiefly, in very free venajsections. His opinion of calomel and bathing, particularly the former, is similar to Dr. R. Jackson's, ?As the Editors of the New-England Journal have done us the honour to adopt our review of the Medico-Chirurgical Transactions, we make no apology for availing ourselves of their labours on a work which we have not yet been able to procure, especially as it affords us an opportunity of offering the opinions of others on nosology and contagion.] perhaps more than any other person, to diffuse among medical men those principles of physiology and of pathology which now prevail, yet his own peculiar theories scarcely find a single defender among the physicians of our day. ' His works, and that before us more particularly, are highly valued and are diligently read, but not for the sake of the peculiar theories they present to us. The excellence of Dr. Cullen is, that he gives his descriptions and his theories distinctly; and that he is peculiarly clear and just in his delineations of disease. As a systematic writer, he is, perhaps, unrivalled in this respect. In regard to individual diseases, there are, no doubt, many who have given descrip,.
tions as faithful, and, of course, more full and minute, than those of Cullen.
But the merits of this distinguished teacher are universally known, and we have not taken up the work before us with an intention to review his writings. Our business is with this edition of the " First Lines, &c." in which is found much matter peculiar to itself. This matter consists ot a x 2 preface 3 56 Critical Analysis* preface and a preliminary discourse, and of numerous notes or commentaries. In these notes, the intention of the editor is, not to explain the doctrines of the original work, but to furnish corrections in respect to theory, and to supply deficiencies in respect to practice. As the editor is a gentleman who ranks very high among the physicians of Philadelphia for his literary and scientific attainments, the additions which he makes to this valuable work must be regarded with interest.
But this interest is much increased by what appears in the prolegomena, viz. that this work comes out under the {sanction of the present Professor of the Theory and Practice of Physic in the University of Pennsylvania; and that he adopts it as his test-book. Even more, we are informed that the editor has had access to some of Dr. Chapman's manuscript lectures, from which he has enriched his work, and from which, in two or three instances, he has given us extracts.
The opportunity of learning the doctrines and precepts inculcated in the first medical school in our country, and, if the number of its pupils be a criterion, one of the first in the world, cannot be regarded with indifference.
But it must be known, that the doctrines referred to are wot those which we have hitherto received from the Philadelphia school. Those were the doctrines of Rush; and, ?whether correct or not, we deem it certain, that his persuasive eloquence, and the force of his genius, caused them to be received with very little opposition during his life, by those who resorted to his lecture-room. Now that the voice of their author has ceased to resound on the ears of his pupils, these doctrines must rest on their own merits alone; and it remains to be seen which of them are placed on stable foundation, and which upon the personal influence of the celebrated Professor. Already it seems, that, under the sanction of the successor of Dr. Rush, there is a formal attempt to overthrow his most favourite principles, and almost to expose his system to derision.* * We cannot believe that Dr. Rush would wantonly submit any thing from Dr. Cullen to derision; still less that Dr. Rush's successor would be guilty of such indecency to the illustrious dead.
We are perfectly of opinion that nosology is liable, like all artificial arrangements of nature, and probably more than any other, to appear hi a very disadvantageous attitude. Of the unity of diseases we shall say nothing till Dr. Rush's words and arguments are stated. \Ve have already announced a very learned work on Nosology, which, if leisure permits, will appear in our next, and to which we promise the. same candour as it is always our wish to show. Our opinion on that subject is very well known, but we trust it will not influence us. If it should, our readers will not question our good intentions, however they may doubt our impartiality.-? London Editor.
To Dr. Cullen's First Lines of the Practice of Physic. 157 "To those, who, for the last fourteen years, have been conversant with the history of medicine in the United States, it is perfectly known, that a bold and persevering attempt was made, by the late Dr. Rush, to overthrow entirely Methodical Nosology, and erect, on its ruins, his favourite hypothesis of the Unity of Disease. Nor was he altogether unsuccessful in the pursuit ot his enterprise. By a combination of popular and imposing qualities, superadded to an ascendancy derived from his station as a public teacher, he implanted in the minds of no inconsiderable portion of the physicians of America, a disbelief in the truth and value of classical medicine. " To endeavour to counteract this evil, which, from the simplicity it appeared to have introduced into medical science, had become exceedingly seductive of indolent minds; to recall the prevalence of correct principles, touching the subdivisions and classification of disease ; and, to restore to our profession the advantages of system, constitute the object of our Preliminary Discourse."?Preface to American edit. p. ix. Accordingly, in the preliminary discourse, Dr. Caldwell points out the true basis of system and classification in science, viz. " affinity in some points, and dissimilarity in others and he shows the object and tendency of this classification. He illustrates its importance, and the benefits to be derived from it, by a reference to the various branches of natural history, and particularly to zoology. The only question is, whether diseases are susceptible of a similar arrangement. Dr. Rush thought that they were not, but Dr. Caldwell says that they are, since they have affinity in some points and dissimilarity in others; and subsequently he shows, that Rush himself had in effect a system of nosology.
In his endeavours to establish the differences among diseases, Dr. Caldwell is led to consider the doctrine of unity of disease promulgated by Dr. Rush. On this doctrine were grounded the principal objections of this learned Professor to systematic nosology, and, if that can be proved to be untenable, the superstructure raised upon it must be deserted. The editor of this work contends, that the doctrine of the unity of disease implies the unity of excitability and the unity of stimuli. The editor himself seems to us not to distinguish sufficiently between sensibility and irritability, properties essentially different and perfectly distinct; but which, by Brown and his followers, are not distinguished at all. Without, however, availing himself of this distinction, the two properties being comprehended under the term excitability, Dr. Caldwell satisfactorily disproves the doctrines in question. In truth, we doubt exceedingly whether any physician ever lived, who, after one year's practice, verily believed that all stimuli produce the same effects, and that all parts of tlie body are affected in the same mode by the same stimuli.
In 158 Critical Analysis, In the conclusions at which Dr. Caldwell arrives, in regard to the doctrine of unity of disease, and in regard to the importance of a systematic arrangement of diseases, we fully accord with him; but we would not be understood as assenting to all the opinions expressed in his preliminary discourse. In the preference which he gives to Cullen's system of nosology over any other extant, he will, no doubt, be supported by the majority of voices; but, for ourselves, we cannot be so decided in preferring Cullen to Sauvages, not to bring into view the systems of any later writers. We shall fully agree, however, with Dr. Caldwell, in lamenting the imperfection of all the systems of nosology, and we think it would not be difficult to point out certain radical defects in them all. That they all have important defects, Dr.